Provider Demographics
NPI:1821188285
Name:SEBRELL, DEBORAH M (MA, CCC/SLP)
Entity Type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:M
Last Name:SEBRELL
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BRISCO ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-4601
Mailing Address - Country:US
Mailing Address - Phone:601-668-0992
Mailing Address - Fax:
Practice Address - Street 1:1635 BOLING ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-4418
Practice Address - Country:US
Practice Address - Phone:601-366-0123
Practice Address - Fax:601-366-0649
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2527235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125045Medicaid
MS318377YJ5DMedicare PIN